July 1, the birthdate of our great nation, is also the birthdate of Canada’s emblematic health-care system. And this weekend we celebrated the 50th anniversary of the introduction of medicare in Saskatchewan. Now often referred to as unsustainable, this milestone provides an opportunity to reflect on the hardfought accomplishments of the past, to re-evaluate today’s system and to consider the growing debate about its future.

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Until 50 years ago, Canada’s health-care system was based on the private, for-profit model. Patients individually paid for the services of medical professionals and hospitals. Often, those who could not afford health care did not receive it, and even some who could did so by deferring treatment, hoping to save their family budget. Since then we have built a national system, lauded around the world, that allows us all access to high-quality care.

The achievement of universal health care took a long, acrimonious and protracted road. It is no surprise to me that Saskatchewan was at the forefront of this journey. The province’s citizens learned many hard lessons during the desperation of the Great Depression and the sacrifices of the Second World War. They learned about generosity, about hardship and fairness, about boom and bust. They learned about the imperative for co-operative action. They came to understand that the notion of shared destiny was key to our existence.

And so it is with other regions in Canada, where geography and demographics may vary, where many waves of immigration began with an initial sense of isolation, but where we all learned to see survival and progress as a test of our ongoing ability to come together and to remain united around shared values.

Canada’s history offers a strong and rich legacy of success that has forged our country. It is this legacy of a shared destiny that is key to understanding our young but dynamic history. Today, as we find ourselves living in complicated times, I believe it is this same legacy that remains the road map to our future, at home and abroad.

Before we give in to despair around the present-day mantra that our system is unsustainable, there are a few things we must consider. First, a universal, single-payer, public insurance model is both less costly and produces better population health outcomes than multipayer systems like the one that exists in the United States. This has been proven time and time again by study after study. Questions of sustainability can never be successfully addressed by moving incrementally backward to a private, for-profit model, at least not the sustainability of a system that remains accessible to all of us.

Second, if our political leaders are genuine in their desire to rein in health costs while maintaining a system for all of us, our task is clear, if not without difficulties. We must lay the groundwork for including catastrophic drug costs and bringing aspects of home care, long-term care and access to advanced diagnostic services into our not-for-profit system. Otherwise, costs will continue to escalate – without restraint and with relentless abandonment of those in need.

Third, we must also recognize that the well-being of our citizenry goes beyond health care; it is dependent on preventing illness and tackling the more fundamental barriers to good health, including social, economic and environmental factors. How we treat the environment has a direct impact on our health and the longevity of a sustainable economy. The growing gap between the rich and poor directly affects our health and the fiscal demands on our health-care system.

Every day, Canada faces new challenges that prompt key questions about what kind of people we are and what kind of future we wish to shape.

As we celebrate the birth of our nation and of medicare, we must ask ourselves: What kind of Canada do we want? Because, as I see it, the choice Canadians make about health care is fundamentally intertwined with our values and future.

Roy J. Romanow is co-chair of the Canadian Index of Wellbeing advisory board and a former commissioner of the Royal Commission on the Future of Health Care in Canada.

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